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The impact of soy consumption on breast cancer prevention and treatment is not clear although many women believe soy supplementation is beneficial based primarily on results from epidemiological studies. Moshe Shike, M.D., from the Department of Medicine at Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College in New York, NY, and colleagues conducted a randomized placebo-controlled study of the effects of soy supplementation on gene expression and markers of breast cancer risk among women diagnosed with invasive breast cancer. The study, run between 2003 and 2007 at Memorial Sloan-Kettering, enrolled a total of 140 patients who were randomized to either soy supplementation (soy protein) or placebo (milk protein), which lasted from the initial surgical consultation to the day before surgery (range=7-30 days). Tumor tissues from the diagnostic biopsy (pre-treatment) and at the time of resection (post-treatment) were then analyzed. They observed changes in several genes that promote cell cycle progression and cell proliferation among women in the soy group.

The authors conclude, “These data raise concern that soy may exert a stimulating effect on breast cancer in a subset of women.”

In an accompanying editorial, V. Craig Jordan, O.B.E., D.Sc., Ph.D., FMedSci, from the Department of Oncology at the Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, discusses how timing of soy supplementation is critical and reviews the evidence in the literature on phytoestrogens, which are contained in soy, and their known action in breast cancer. He writes, the study by Shike et al. “…illustrates the dangers of phytoestrogen consumption too soon, around menopause, but the biology of estrogen in estrogen-deprived conditions suggests that phytoestrogen could have benefit a decade after menopause.” He cautions that appropriate doses of soy and timing of consumption are critical considerations.

“There have been some concerns that one of the reasons why breast cancer may be more common in developed countries compared with developing countries is differences in bra-wearing patterns,” said Lu Chen, MPH, a researcher in the Public Health Sciences Division at Fred Hutchinson Cancer Research Center and a doctoral student in the Department of Epidemiology at the University of Washington School of Public Health. “Given how common bra wearing is, we thought this was an important question to address.

“Our study found no evidence that wearing a bra increases a woman’s risk for breast cancer. The risk was similar no matter how many hours per day women wore a bra, whether they wore a bra with an underwire, or at what age they first began wearing a bra,” said Chen.

“There has been some suggestion in the lay media that bra wearing may be a risk factor for breast cancer. Some have hypothesized that drainage of waste products in and around the breast may be hampered by bra wearing. Given very limited biological evidence supporting such a link between bra wearing and breast cancer risk, our results were not surprising,” Chen added.

According to the study authors, this study characterizes various bra-wearing habits in relation to breast cancer risk using a rigorous epidemiological study design. “The findings provide reassurance to women that wearing a bra does not appear to increase the risk for the most common histological types of postmenopausal breast cancer,” the authors noted.

Study participants were 454 women with invasive ductal carcinoma (IDC) and 590 women with invasive lobular carcinoma (ILC), the two most common subtypes of breast cancer, from the Seattle-Puget Sound metropolitan area; 469 women who did not have breast cancer served as controls. All women were postmenopausal, ages 55 to 74.

The researchers conducted in-person interviews and obtained information on demographics, family history, and reproductive history. They also asked a series of structured questions to assess lifetime patterns of bra wearing. Questions included age at which the study participant started wearing a bra, whether she wore a bra with an underwire, her bra cup size and band size, the number of hours per day and number of days per week she wore a bra, and if her bra-wearing patterns ever changed at different times in her life.

No aspect of wearing a bra was associated with an increased risk for either IDC or ILC.

Although Medicaid is a joint state-federal government health insurance program, each state sets the policies for its own Medicaid program within requirements set by the federal government. This includes setting how much providers are paid for health care services and who is allowed to enroll in Medicaid. To determine whether state Medicaid eligibility and reimbursement policies affect receipt of breast, cervical, and colorectal cancer screening among Medicaid beneficiaries, Michael Halpern, MD, PhD, MPH, of RTI International, and his colleagues analyzed 2007 Medicaid data from 46 states and Washington DC.

“Few studies have examined how state-specific differences in Medicaid policies might affect use of preventive care services, particularly for early detection of cancer,” said Dr. Halpern. “Our study was able to compare differences in cancer screening for Medicaid beneficiaries in almost all states, providing a broad, national picture of the effects of state-level Medicaid policies on receipt of these critical medical care services among a large group of underserved individuals.”

The researchers found that in states with higher payments for office visits, Medicaid beneficiaries were more likely to receive recommended screenings for early detection of all three types of cancer. In contrast, higher payments for cancer screening tests (such as colonoscopy, mammography, and Pap tests) were not always linked with increased screenings among Medicaid beneficiaries. The team also found that Medicaid beneficiaries in states that had an “asset test” (which considers an individual’s savings, property, or other items of worth to determine whether he or she could enroll in Medicaid) were less likely to be screened for cancer.

The association between higher Medicaid reimbursements for office visits and increased likelihood of receiving cancer screenings may reflect barriers in access to primary care physicians and other providers for Medicaid enrollees in states with lower reimbursements. Increasing reimbursements for office visits may facilitate access to primary care among Medicaid beneficiaries, and thereby increase the likelihood of receiving appropriate cancer screening tests. On the other hand, raising reimbursement for the screening tests themselves may be a less effective policy tool for increasing use of recommended screenings. The results also indicate that eliminating asset tests may increase the likelihood of receiving cancer screenings by helping low-income individuals remain enrolled in Medicaid.

“Due to multiple factors, including Health Care Reform and decreased state budgets, many states are changing their Medicaid policies, including how much health care providers are paid and who is allowed to enroll,” said Dr. Halpern. “Our findings can help state health care decision makers and policy leaders to develop new Medicaid policies that aid low income individuals in receiving recommended cancer screenings.”